Xu C H, Zhu G Q, Lin Q S, Wang L L, Wang X X, Gong J Y, Zhao N N, Yang D L, Feng S Z
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2020 Aug 14;41(8):643-648. doi: 10.3760/cma.j.issn.0253-2727.2020.08.005.
To investigate the distribution of pathogens and the antibiotic resistance profile of bloodstream infections in adult patients with hematological diseases in the period 2014-2018 to provide evidence for the rational use of antibiotics. We retrospectively analyzed the bloodstream infections in patients with hematological diseases from January 2014 to December 2018 at the institute of Hematology & Blood Diseases Hospital; this included an assessment of the clinical characteristics, distribution of pathogens, and antibiotic resistance data. There were 1935 episodes of BSIs in the 1478 patients who were studied; among these, 1700 episodes occurred in the neutropenic phase. The 7-day and 30-day all-cause mortality rates were 5.5% and 8.2%, respectively. Bloodstream infection was usually accompanied by respiratory tract, perianal zone mucositis, and digestive tract symptoms; the respective proportions were 12.4%, 12.3%, and 9.1%, respectively. Total 2025 strains were isolated; 1551 (76.6%) of the pathogens were gram-negative bacteria, mainly Escherichia coli, Klebsiella pneumonia, and Pseudomonas aeruginosa; 423 (20.9%) were gram-positive bacteria, mainly Staphylococcus spp. and Streptococcus spp. Viridans; 51 (2.5%) were fungi, mainly Candida tropicalis. The resistance rates of Enterobateriaceae to piperacillin/tazobactam, carbapenems, amikacin were <10%. The resistance rates of K. pneumoniae to cefepime, piperacillin/tazobactam and meropenem increased annually. The resistance rates of Pseudomonas aeruginosa to piperacillin/tazobactam, quinolones, Aminoglycosides were <5% even when compared to carbapenems. Eleven stains of methicillin-resistant S. aureus and 1 stain of vancomycin-resistant Enterococcus faecium were detected. The pathogens of bloodstream infection in adult patients with hematological diseases are widely distributed. The resistance rates of different strains vary; the rates in some species had a tendency to increase. Antibiotics should be selected rationally as per the distribution of pathogens and resistance to antibiotics in different patient groups.
调查2014 - 2018年期间血液系统疾病成年患者血流感染的病原体分布及抗生素耐药情况，为合理使用抗生素提供依据。我们回顾性分析了2014年1月至2018年12月在血液学与血液疾病医院研究所住院的血液系统疾病患者的血流感染情况；这包括对临床特征、病原体分布和抗生素耐药数据的评估。在1478例研究患者中发生了1935次血流感染事件；其中，1700次事件发生在中性粒细胞减少期。7天和30天的全因死亡率分别为5.5%和8.2%。血流感染通常伴有呼吸道、肛周区域粘膜炎和消化道症状；各自的比例分别为12.4%、12.3%和9.1%。共分离出2025株菌株；1551株（76.6%）病原体为革兰阴性菌，主要是大肠埃希菌、肺炎克雷伯菌和铜绿假单胞菌；423株（20.9%）为革兰阳性菌，主要是葡萄球菌属和草绿色链球菌；51株（2.5%）为真菌，主要是热带念珠菌。肠杆菌科对哌拉西林/他唑巴坦、碳青霉烯类、阿米卡星的耐药率<10%。肺炎克雷伯菌对头孢吡肟、哌拉西林/他唑巴坦和美罗培南的耐药率逐年上升。即使与碳青霉烯类相比，铜绿假单胞菌对哌拉西林/他唑巴坦、喹诺酮类、氨基糖苷类的耐药率<5%。检测到11株耐甲氧西林金黄色葡萄球菌和1株耐万古霉素粪肠球菌。血液系统疾病成年患者血流感染的病原体分布广泛。不同菌株的耐药率各不相同；某些菌种的耐药率有上升趋势。应根据不同患者群体中病原体的分布和对抗生素的耐药情况合理选择抗生素。
